Compliance of spectacle wear among school children.

Purpose: In India, school eye screening is an important component of the National Programme for the Control of Blindness providing spectacles free of cost to children from primary section. The primary aim of this study was to know the compliance of wearing spectacles provided during school screening program and to find out reasons for noncompliance. The secondary aim of this study was to get information regarding the types of modifications required in the school eye screening program to improve the compliance level. Methods: It was a cross-sectional follow-up study involving school children of age group 10-16 years, class 5-9 from different parts of the country. Public or private schools were randomly selected based on their distance from the base hospitals/partner organizations. Data were collected by standard format directly from the students after informed written consent from school principal or class teacher. Results: The utilization of spectacles was found to be only 29.8% (n = 289) within 2 years of receiving the spectacles. Thirty-five percent (n = 108) students were using spectacles with less than 0.75 D. Appearance of the frame was a deciding factor. It was observed that the frames provided by the DBCS were especially not liked by the children. Twenty-five percent (n = 79) children were found to be wearing adult frames. Conclusion: Less than a third of the students were compliant with their spectacle prescription in this study. To improve the compliance, children should not be prescribed spectacles for nonsignificant refractive errors, should be given choices for frames and quality of work being conducted under school screening program needs a review.

Impact of cataract surgery in reducing visual impairment: a review.

PURPOSE: The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. MATERIALS AND METHODS: A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. RESULTS: There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. CONCLUSION: Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.

Patient satisfaction regarding eye care services at tertiary hospital of central India.

PURPOSE: To evaluate patients' satisfaction regarding eye care services and suggest policy changes accordingly. STUDY DESIGN: Descriptive study. MATERIALS AND METHODS: This study was conducted between September 2005 and June 2006. Patients attending the eye clinic of Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India, and admitted as in-patients in this hospital were our study population. Randomly selected patients were interviewed by trained staff. Close-ended questionnaire was used to conduct these structured interviews. Their responses were grouped into one of five categories and evaluated to determine satisfaction for different components of eye care services. RESULTS: Three hundred and twenty persons were interviewed. The satisfaction was of excellent grade among 77 (48.1%) patients attending clinic and 156 (97.5%) patients who were admitted in the hospital. The participants expressed dissatisfaction for the long waiting period in clinics, poor cleanliness, and insufficient toilet facilities. Those admitted in the hospital felt that food facilities were less than the expected quality. Child-friendly facilities received high satisfaction scores. CONCLUSION: Although eye care services both in clinics and in the wards were satisfactory according to the end-users, there are scopes for improvement. Patient satisfaction surveys should be encouraged in hospitals for better accountability and also for strengthening the quality of eye care services.

Visual acuity at 6 weeks after small incision cataract surgery and role of audit in predicting visual acuity.

PURPOSE: We present the best-corrected visual acuity (BCVA) at 6 weeks after small incision cataract surgery (SICS) and review the role of audit in predicting visual acuity (VA). METHODS: This was a retrospective data analysis of 14,393 SICS performed during 2007-2008 at a hospital in central India. Ophthalmologists noted preoperative, operative, and postoperative details. The BCVA before and 1 day and 6 weeks after surgery were noted. We identified factors associated with BCVA at 1-day and 6-week follow-up. RESULTS: Six weeks after surgery, 12,522 (87%) and 1473 (10.2%) patients had BCVA > or =6/18 and 6/24-6/60, respectively. Vision improved between 2 follow-ups in 6695 eyes (46.5% (95% confidence interval (CI) 45.7-47.3)), remained the same in 7117 eyes (49.4%), and deteriorated in 544 (3.8%) eyes. BCVA at 6 weeks was negatively associated with blindness (VA <3/60 in the better eye) before surgery (odds ratio (OR) = 0.73, 95% CI 0.58-0.92), surgeon's experience (OR = 0.75, 95% CI 0.71-0.81), and male patients (OR = 0.73, 95% CI 0.67-0.80). BCVA at 6 weeks was positively associated with older age (OR = 1.02, 95% CI 1.01-1.03) and intraoperative complications (OR = 1.44, 95% CI 1.14-1.83). The association of VA <6/60 1 day after surgery with improved vision between the 2 follow-ups was not statistically significant (OR = 0.005, p = 0.98). CONCLUSIONS: BCVA at 6 weeks after SICS was > or =6/18 in 87% of operated eyes. By performing surgical audit, one can identify high-risk groups that need proactive subsequent follow-ups.

Effectiveness of using teachers to screen eyes of school-going children in Satna district of Madhya Pradesh, India.

AIM: To assess the effectiveness of teachers in a vision screening program for children in classes 5th to 12th attending school in two blocks of a district of north central India. MATERIALS AND METHODS: Ophthalmic assistants trained school teachers to measure visual acuity and to identify obvious ocular abnormalities in children. Children with visual acuity worse than 20/30 in any eye and/or any obvious ocular abnormality were referred to an ophthalmic assistant. Ophthalmic assistants also repeated eye examinations on a random sample of children identified as normal (approximately 1%, n=543) by the teachers. Ophthalmic assistants prescribed spectacles to children needing refractive correction and referred children needing further examination to a pediatric ophthalmologist at the base hospital. RESULTS: Five hundred and thirty teachers from 530 schools enrolled 77,778 children in the project and screened 68,833 (88.50%) of enrolled children. Teachers referred 3,822 children (4.91%) with eye defects for further examination by the ophthalmic assistant who confirmed eye defects in 1242 children (1.80% of all screened children). Myopia (n=410, 33.01%), Vitamin A deficiency (n=143, 11.51%) and strabismus (n=134, 10.79%) were the most common eye problems identified by the ophthalmic assistant. Ophthalmic assistants identified 57.97% referrals as false positives and 6.08% children as false negatives from the random sample of normal children. Spectacles were prescribed to 39.47% of children confirmed with eye defects. CONCLUSIONS: Primary vision screening by teachers has effectively reduced the workload of ophthalmic assistants. High false positive and false negative rates need to be studied further.

Pediatric cataract and surgery outcomes in Central India: a hospital based study.

BACKGROUND: A review of pediatric cataract cases operated between January 2003 and March 2005 in the tribal belt of central India was carried out. AIM: We present the profile of cataract cases in children